Psychiatry Billing Services

What psychiatry billing covers

Fastora provides psychiatry billing services and psychiatry medical billing for psychiatrists, psychiatric mental health nurse practitioners (PMHNPs) and group practices. Psychiatry billing sits between medicine and behavioral health: one visit can include a medical E/M service, psychotherapy, a medication decision and a prior authorization, and each part follows its own rules.

Visits are shorter and more frequent than in therapy practices, and medication management drives most of the volume. A practice that bills only the E/M when psychotherapy was also delivered leaves documented work unbilled, while one that adds psychotherapy without separate documentation risks recoupment on review.

Psychiatric medical billing also covers procedures that therapy practices rarely see, such as transcranial magnetic stimulation, supervised esketamine sessions and monthly care management codes. Every claim is handled by certified medical billing and coding professionals who know how these services combine on the same patient.

Codes we bill every day

Medication management visits are billed with office or outpatient E/M codes, with the level chosen by medical decision making or total time under the AMA E/M guidelines. Initial assessments by prescribers use 90792, psychiatric diagnostic evaluation with medical services, which adds medical elements such as medication history and a medical assessment. Clinicians who do not provide medical services use 90791 instead.

Under CPT rules, 90791 and 90792 are not reported with an E/M service on the same day by the same clinician. Many payers also limit repeat diagnostic evaluations unless the record shows a reason, such as a new episode of care. Our coders check these pairings before claims go out.

E/M with psychotherapy add-ons

Psychiatry E/M coding follows the AMA office visit guidelines: the level is chosen by medical decision making or by total time on the date of service. Psychotherapy add-on code billing changes that choice, because the time used for psychotherapy cannot also support the E/M.

When a psychiatrist provides psychotherapy during a medication visit, the psychotherapy is reported with an add-on code alongside the E/M. CMS billing guidance requires the two services to be significant and separately identifiable, and states that time spent on E/M activities is not counted toward psychotherapy time.

That has two practical effects. First, the E/M level must be chosen by medical decision making, because time cannot be the basis for E/M selection when an add-on is billed. Second, the note should record psychotherapy minutes on their own, for example 20 minutes of supportive therapy after the medication review, which fits the range for 90833.

• 90833: 16 to 37 minutes of psychotherapy with the E/M
• 90836: 38 to 52 minutes
• 90838: 53 minutes or more
• 90785 may be added when interactive complexity criteria are met

Prolonged service codes are not reported with these combined services, according to the same CMS guidance. Our article on the 90833 add-on code shows how a typical medication visit with brief therapy is documented and coded.

More detail: billing 99214 with 90833 and the psychiatric diagnostic evaluation codes 90791 and 90792.

Medication management billing

There is no single medication management billing CPT code for physicians and nurse practitioners. A follow-up visit to review response, side effects and dosing is billed with an office or outpatient E/M code, most often an established patient code from 99212 to 99215, with the level supported by the problems addressed, data reviewed and risk of the prescribing decision.

Psychiatric practices handle two kinds of approvals around medication. Prescription prior authorizations go through the patient's pharmacy benefit and are handled by the clinical team. Long-acting injectables bought and given in the office are billed on the medical claim with a HCPCS drug code in the units that code defines, an administration service and, for many Medicaid programs and commercial payers, the National Drug Code (NDC). Mismatches between the dose given and the HCPCS unit definition are a common cause of denials and underpayment.

Video visits suit medication management. Medicare uses POS 10 for telehealth in the patient's home and POS 02 for other locations, and permits audio-only services in defined circumstances with modifier 93; commercial and Medicaid plans may require modifier 95 or their own conventions. Prescribing controlled substances by telehealth is governed by federal DEA rules and state law, which the practice confirms on the clinical side.

We submit medical-benefit authorization requests with the clinical history payers ask for, track approval dates and doses, and attach the authorization number to each claim. Learn how our authorization support works.

TMS & Spravato billing

Transcranial magnetic stimulation

TMS is reported with three codes: 90867 for the initial session, including cortical mapping, motor threshold determination and delivery and management; 90868 for each subsequent delivery and management session; and 90869 for a subsequent session that includes motor threshold re-determination. Payers usually approve a set course of treatment after documented trials of antidepressant medication and psychotherapy, and some require reassessment before approving more sessions.

Reimbursement for TMS comes from the payer's fee schedule or contract rate for each code, multiplied by the sessions approved, so tracking the approved session count is as important as the codes. Our guide to TMS billing covers authorization criteria and session tracking.

Esketamine (Spravato)

Medicare created G2082 and G2083 for an established patient visit that requires supervision of esketamine nasal self-administration, including 2 hours of post-administration observation. G2082 applies to doses of up to 56 mg and G2083 to doses greater than 56 mg. The treatment is given in a certified setting under the manufacturer's REMS program, and most payers require authorization.

Payers differ on whether they accept the G-codes or want E/M and observation billed another way, and on whether the drug is billed by the practice or supplied through a specialty pharmacy. We confirm both before the first session. See our article on Spravato billing for details.

Collaborative care (CoCM) billing

In the psychiatric collaborative care model, a treating practitioner (often primary care) works with a behavioral health care manager and a psychiatric consultant. The treating practitioner bills these codes, and the psychiatric consultant is typically paid under an arrangement with that practice rather than billing the codes directly.

CMS lists requirements for these services, including validated rating scales, a care plan and, for collaborative care, a registry and regular psychiatric consultant review. For practices that bill them, we track monthly minutes so each code is supported. Our collaborative care billing article explains the time thresholds.

Psychiatric nurse practitioner billing (PMHNP billing)

PMHNPs bill the same E/M, 90792 and psychotherapy add-on codes as psychiatrists, within their state scope of practice. Under Medicare, a nurse practitioner who bills under their own NPI is paid a reduced percentage of the physician fee schedule amount, while services that meet Medicare's incident-to rules can be billed under the supervising physician.

Incident-to billing has strict conditions: the physician starts the plan of care for the problem, provides direct supervision as CMS currently defines it, and stays actively involved. New patients and new problems generally do not qualify, and many commercial plans and Medicaid programs do not recognize incident-to at all. We set the rendering provider on each claim according to the payer's rules, because a PMHNP visit billed under the wrong clinician is a common audit finding.

Psychiatrists and psychiatric nurse practitioners must also be enrolled with each payer, and often separately with carved-out behavioral health administrators, before claims pay. Credentialing for psychiatrists and NPs follows Fastora's tracked nine-stage process, from consultation and document collection to NPI and CAQH setup, payer applications, panel submissions, follow-ups and final approval. See our credentialing and enrollment service.

Outsourced psychiatric billing: how Fastora works

As a psychiatric billing company, Fastora works inside your existing EHR/PM system under the user access you grant, with no software to install and no hidden setup fees. If your practice runs Valant, for example, our Valant billing services are delivered inside your own account; Fastora has no official integration or partnership with any software vendor.

Psychiatry revenue cycle management follows our three-phase workflow: the Virtual Assistant phase handles scheduling, registration, benefits checks and copays collected upfront; the Scriber phase records visit documentation in real time, so E/M work and psychotherapy minutes are captured as they happen; and the billing phase covers claim submission, payment posting, denial management, AR follow-up and patient billing.

Claims pass through Advanced Pre-Submission Claim Review, which targets the denials we see most often in psychiatry:

• Psychotherapy add-on billed without separate time documentation, or with the E/M level chosen by time
• 90792 billed on the same date as an E/M by the same clinician
• Injectable drug claims with units that do not match the HCPCS definition, or a missing NDC
• Treatment delivered after an authorization expired or under the wrong benefit
• Claims sent to the medical plan when behavioral benefits are carved out
• Nurse practitioner services submitted under the wrong rendering provider

When you compare a psychiatry medical billing company, ask who reviews add-on pairing, how drug units are checked and what you will see each month. Each Fastora practice has a dedicated account contact, transparent dashboards, monthly performance reporting and a monthly review call. Fastora quotes after a free billing assessment; our pricing page explains the models we offer. Practices that also employ therapists or psychologists get one team across every license type, as described on our behavioral and mental health billing hub.